Economic evaluation of anti-CD19 CAR T-cell pathway for large B-cell lymphomas in the real-life setting: the experience of an Italian hub center in the first three years of activity.

Poor literature report actual and detailed costs of chimeric antigen receptor (CAR) T-cell pathway in a real-life setting. We retrospectively collect data for all patients with relapsed/refractory aggressive large B-cell lymphoma who underwent leukapheresis between August 2019 and August 2022. All costs and medical resource consumption accountability were calculated on an intention-to-treat (ITT) basis, starting from leukapheresis to the time when the patient (infused or not) exited the CAR T-cell pathway for any reason. Eighty patients were addressed to leukapheresis and 59 were finally infused. After excluding CAR-T product cost, the main driver of higher costs were hospitalizations followed by the examinations/procedures and other drugs, respectively 43.9%, 26.3% and 25.4% of the total. Regarding costs of drugs and medications other than CAR T products, the most expensive items are those referred to AEs, both infective and extra-infective within 30 days from infusion, that account for 63% of the total. Density plot of cost analyses did not show any statistically significant difference with respect to the years of leukapheresis or infusion. To achieve finally 59/80 infused patients the per capita patients without CAR-T products results 74,000 euros. This analysis covers a growing concern on health systems, the burden of expenses related to CAR T-cell therapy, which appears to provide significant clinical benefit despite its high cost, thus making economic evaluations highly relevant. The relevance of this study should be also viewed in light of continuously evolving indications for this therapy.

The Treatment of Burkitt Lymphoma With the Berlin-Frankfurt-Münster Protocol With Rituximab and Consolidative Autologous Transplantation.

INTRODUCTION: Intensive treatment approaches are required for adult patients with Burkitt lymphoma (BL), although an univocal standard of care still does not exist. The use of frontline autologous stem cells transplantation (ASCT) is debated. PATIENTS AND METHODS: Between 2004 and 2020, 50 patients with BL were treated with the Berlin-Frankfurt-Münster (BFM). Treatment plan consisted of 3 blocks, A (ifosfamide, vincristine, methotrexate, etoposide, and cytarabine), B (vincristine, cyclophosphamide, methotrexate, and doxorubicin), and C (vindesine, methotrexate, etoposide, and cytarabine), each repeated twice, every 28 days. Rituximab was given at day 1 each block. Intrathecal prophylaxis was given once per each block. ASCT was scheduled at the end of the 6 blocks after conditioning. RESULTS: Median age at onset was 38 years (range 16-72); stages III-IV disease was observed in 82% of cases; bulky disease occurred in 44% of the patients, with B-symptoms in 38%. Stem cell harvest was performed in 72% of patients, who all received a subsequent ASCT. The full 6 blocks treatment was completed in 70% of the patients. The overall response rate was 74%, with a complete response rate of 60%. Ten-year overall survival and progression-free survival were 83.7% and 76.0%, respectively, without reaching the median. Ten-year disease-free survival was 80.3%. Grades 3-4 neutropenia, thrombocytopenia, anemia, and mucositis were seen in 96%, 60%, 32%, and 24% of patients. Infections occurred in 60% of patients. CONCLUSION: Intensive treatment according to BFM protocol, with rituximab and ASCT, appears feasible, safe, and highly effective in adult patients with BL, as confirmed by long-term survival rates reflecting response maintenance.

Escherichia coli J5: imunização de fêmeas bovinas leiteiras contra mastites causadas por Escherichia coli / Escherichia coli J5: immunization of dairy cows against Escherichia coli mastitis

Neste trabalho, revisamos os principais aspectos ligados à mastite causada por coliformes, mais especificamente a Escherichia coli, com enfoque principal nos fatores de risco associados ao animal, bem como na utilização da vacina Escherichia coli J5 na imunização de fêmeas bovinas leiteiras. Os coliformes estão amplamente distribuídos no ambiente, assumindo especial importância em sistemas de criação em que a busca pela qualidade do leite mantém a contagem de células somáticas (CCS) em níveis inferiores a 150000 células ml-1. Nesse contexto, o período seco representa um momento de extrema importância na definição da ausência ou não de um quadro de mastite, decorrente da ação de patógenos ambientais no pós-parto imediato. A terapia para vacas secas frente a infecções por germes ambientais perde eficácia, sendo necessária a associação a outros métodos, como, por exemplo, a vacinação com Escherichia coli J5. A cepa J5, por possuir um antígeno nuclear relativamente exposto, é capaz de estimular a produção de imunoglobulinas que apresentam reação cruzada com antígenos nucleares de outras bactérias, resultando em uma imunidade contra uma variedade de gêneros e cepas bacterianas. Estudos demonstram que a vacinação com Escherichia coli J5 é capaz de reduzir a ocorrência, intensidade e duração de casos clínicos de mastite por Escherichia coli, sendo também observada uma maior produção de leite nos animais vacinados. Entretanto, ainda é controverso seu papel na redução da CCS.

This paper aims to review the main aspects of coliform mastitis, specifically Escherichia coli, emphasizing the immunization of dairy cows with Escherichia coli J5 vaccine, as well as the animal risk factors. Coliforms are widespread in the environment and are of particular importance in farming systems in which the search for a greater milk quality guarantee low somatic cell counts (<150,000 cells ml-1). The dry period is an extremely important moment that plays crucial role in the occurrence of mastitis caused by environmental pathogens during the immediate postpartum. The dry cow therapy against environmental infections has lost effectiveness leading to the need for the combination with other methods such as immunization with Escherichia coli J5 vaccine. Due to a relatively exposed nuclear antigen, the Escherichia coli strain J5 can stimulate the production of immunoglobulins that cross-react with nuclear antigens from other bacteria. It results in immunity against a variety of bacterial genres and strains. It has been shown that the use of Escherichia coli J5 vaccine can reduce the occurrence, intensity and duration of clinical cases of Escherichia coli mastitis, besides increase the production of dairy cows. However, its role in reducing milk SCC is still controversial.